Kate Chandler, SpR.
Department of Clinical Genetics
St Mary's Hospital
Central Manchester and Manchester Children's University Hospitals.
How did you train for Clinical Genetics?
It was through Paediatrics that I first came into contact with genetics. Geneticists came to see children with cardiac problems to investigate the reasons for their problems. After two years as a Paediatric Registrar I decided to change to genetics. The experience of working in different departments is invaluable, and I started my training in Leicester, so I also had the experience of working in a different region. My interest and association with paediatric medicine has been maintained in genetics, although there are not really sub-specialties within genetics as it is a new specialty and not yet very large. I cover general and paediatric genetics and one of my colleagues covers general and cancer genetics. I have trained part-time for six years and have just four weeks to go!
What attracted you to Genetics?
The kinds of patients I see. The cases are complicated and interesting. Clinical Genetics is an information giving specialty; it explains why things have happened or why they cannot be explained yet. Research is ongoing and each researcher is investigating a different aspect of genetics. A geneticist needs to have an interest in unusual rare minutiae and the ability to communicate the findings to others who need to know. Chromosome patterns are tested and these are used to explain the genetic problems to the families and the implications for others in the family. Geneticists also inform the other specialties that are involved.
Is there a general working pattern for Geneticists?
It is an outpatient led service. There are no ward rounds or on-call commitments. The number of clinics each week plus the ward referrals provide the bulk of the work. In this area there are clinics to cover places beyond Greater Manchester. For example, I have weekly clinics at the Children's Hospital at Pendlebury. Each clinic can usually accommodate four patients in an afternoon. I also hold a once a month clinic in Blackpool where I see seven patients in one day. There is pre-clinic preparation and after the clinic it is written up and letters of the consultation are sent out to the families and the GPs. So the pattern is: preparation - clinic - tidy up. If a patient is presenting with a rare condition, research has to be carried out prior to the consultation. The Internet is used to search for papers concerning the condition and the specialty networks nationally and internationally to disseminate research and request information and confirmation concerning cases. Evenings are spent doing preparation or work on a MD thesis, PhD or research.
Are there any aspects of it that you particularly like or dislike?
I like all of it. Some aspects such as writing up the MD are hard work - but other specialties have exit exams! There is lots of dictation and it is necessary to be computer literate, but it is satisfying work.
What are the personal qualities needed for the job?
It is self-governing - the geneticist is not governed by ward rounds, so self-discipline is needed to prepare and organise oneself. An investigative and problem solving ability and interest is necessary. Also the communication aspects are unusual. There is pre-natal and post-termination counselling with the family as well as the need to explain the results of scans and chromosome testing to assess the risks to pregnancies. It is not as practical as many other specialties. It is about having prior knowledge rather than thinking on your feet on a ward round. Geneticists have to be able to work on their own and in a team. Working on one's own means setting one's own timetable, structuring one's day and motivating oneself. At the same time there is non-hierarchical teamwork where Genetic Associates (scientists, lab staff, nurses - who have often seen the family beforehand), Registrars and Consultants all contribute their different knowledge in pre-clinic meetings.
How did you manage to train as well as look after your family?
The paediatric job I worked on before becoming a geneticist was advertised as a full-time position. I set up my own job share with another trainee so that I could continue to look after my daughter. My husband then took up a sabbatical in Holland where I worked on a voluntary basis attached to a genetics department to write research papers. My job in Manchester is a flexible training position, which means that I have been able to work between three and four days a week. It is worked out on a pro-rata basis according to the number of sessions and the length of time normally taken for training, e.g. 10/6 x 4 years = 6.7 years. When my daughter was in nursery I worked three days a week. Now that she has started school I work four days a week. I work my hours so that I can leave early enough to pick her up from school. It also means that I have Monday free to write up my MD. Flexible training has to have full-time back up to provide cover for the odd times worked, so it is a team matter, too.